USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 15
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No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a eertificate as hereinafter provided. If there is no attending physiclan, or if, for sufficient reasons, his certificate cannot be obtained carly enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the sclectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thercafter fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition. )
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to Issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made. .. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition)
0741.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Ilealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deathis following abortion, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 AM Suffolk
PLACE OF DEATH
Massachusetes
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No 45
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Mary E. King.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5 Irwin Street, Winthrop,-
St.
(If nonresident, give city or town and state)
months
days.
In this community 30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
Years
6 Age of husband or wife if alive 7 IF STILLBORN, enter that fact here.
If less than I day
8
50
Years
Months.
.Days
Hours
Minutes
At Home
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
Martin King
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Cecelia M. Conroy
Relation, if any cousin
Informant. (Address) So. Main St., Cohasset.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: In. D. Childrenz (Signature of Agent of Board of Health or other) Health Office (Official Designation)
2/28/40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
28
1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
November 1,
1939,
27
to ...
19.40
FEL
That I attended deceased from
I last saw h En alive on 1.sheary 27, 1940, death is said
to have occurred on the date stated above, at ............... Immediate cause of death .. Carcinoma of Stomach -
.. m.
Duration
IMPORTANT
....
7 MAS. ....
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Underline the cause to which death Of autopsy Date of- should be charged sta- What test confirmed diagnosis? NONE.
20 Was disease or Injury In any way related to occupation, ct deceased?
If so, specify M. D. (Signed) Colward, L' Fraunger (Address) 200 Washington And Date Feb, 28 1940.
21
Holy Cross
Malden.
Place of Burial, Cremation Tor . Rem
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
h. Dianer Buckley
ADDRESS
12 Warren St.
albury
Received and filed 19
(Registrar)
100m-10-'39. No. 8427-e
1 3 SEX (or) WIFE of AGE Usual 9 Occupation: PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry 10 or Business:
information should be carciany ouppilede is very important. See instructions and extracts from the laws on back of certificate.
No. 5 Irwin Street, Winthrop.
St.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
years
(write the word)
(Date of Issue of Permit)
PHYSICIAN
tistically.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death. stating to the best of hla knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last iliness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46. Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the cierk of the town where the hody is huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk. as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment. by a satisfactory certificate of the attending physician, if any, as required by law. or In lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons. his certificate cannot be obtained early enough for the purpose, or is insufficient. a physician who is a member of the board of heaith, or employed by it or by the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shail make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as abovo provided and in the possession of the undertaker desiring to make such removai shall constitute a permit for such removai ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner ohtalned hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shali appear upon the permit. The board of heaith, or its agent, upon receipt of such statement and certificate. shail forthwith countersign it and transmit it to the cierk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be obtained as to the deceased. or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sce. 45. G. L., (Tercentenary Edition.)
No undertaker or other person shali bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the hoard of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46. G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physiclans will certify to such deaths only as those of persons to whom they have given bedside care during a last iil- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, thoughi disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(8) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermai. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to orcupa. tion, the sudden deaths of persons not disabled by recognized disoase, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principai cause name the disease causing death. As related causes. name earlier morbid con- ditions, if any, related to the principai cause and any important complication of the prinelpal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to ilinces. If the deceased bad retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) PARENTS
ATTEST:
Charles H. Keinstead
(Registrar of city or town where death occurred)
DATE FILED March 29,
19
40.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
February
19,
1940
(Month)
(Day)
(Year)
I HEREBY CERTIFY,
That I attended deceased from
March &,
1939 .. , toFebruary
79
194.0.
(or) WIFE of
ChafGive gaides name Poach
(Husband's name in full)
6 Age of husband or wife if alive. Years
7 IF STILLBORN, enter that fact here.
AGE 82
Years ..
.11 Months ... 2.8.Days
If less than 1 day
Hours .....
Minutes
Usual 9 Occupation:
Housewife
Industry
10 or Business:
Il Social Security No.
Pembroke
Maine
13 NAME OF
FATHER
Hodgdon Buzzell
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine.
15 MAIDEN NAME
OF MOTHER
Lydia Laighton
IG BIRTHPLACE OF
MOTHER (City)
West Pembroke
(State or country)
Maine.
17 Informant. edfield St. Hospital (Address)
Relation, if any
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
State, Medfield ,Mass.
(Cemetery)
(City or Town)
DATE OF BURIAL
March 26,
40
19
22 NAME OF
FUNERAL DIRECTOR
Joseph A. Roberts
ADDRESS.
Medfield, Mars
Received and fled
19
(Registrar of City or Town where deceased resided)
PHYSICIAN
(Include pregnancy within 3 months of death)
Major findings :
Of operations
None
Date of.
Of autopsy
What test confirmed diagnosis? Phys & Lab
20 Was disease or injury in any way related to occupation of deceased ? NO
(Signed)
If so, specify.
I.A. Berezin
M. D.
(Address)
Harding Mass
Date 2/20, 19 40
Underline the cause to which death should be charged sta- tistically.
...
2/18/40
Other conditions
Bronchopneumonia
Due to
Generalized arterioscler-
osis
Due to
death is said to have occurred on the date stated above, at 6: 15 Fm Duration Immediate cause of death ..
... Arteriosclerotic Heart Disease-years
....
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
Institution25
2
years
months
25 days.
St.
(If U. S.
War Veteran,
specify WAR)
Winthrop, Mass.
46
2 FULL NAME
PLACE OF DEATH
Norfolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Medfield.
(City or town making return) ....
Registered No.
19.
(If death occurred in a hospital or institution,
No.
Medfield. (City or Town) Medfield
State Hospital
St. (
give its NAME instead of street and number)
Ella M. (Buzzell) Roach
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE 5 SINGLE
White
MARRIED
WIDOWED
or DIVORCED
(write the word)
Divorced
5a If married, widowed, or divorced HUSBAND of
of wife in full)
I last saw h ........... alive on
February 19. 40
WWWNE FICES VI tMG GIty of town In Which the deceased resided as soon as possible
R-302
1
A TRUE COPY.
Monroe,
12 BIRTHPLACE (City)
(State or country)
OF TOM?
1.3
6
OP.
MAR301940 AM
D
₹
R- 301 A1
PLACE OF DEATH
...... (County)
1
inthron
(City or Town)
CERTIFICATE OF DEATH
Registered No
S (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Eleanor Mary
( Callaghan) Blazo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
arms Hotel, Grovers .Vst.
(If nonresident, give city or town and state)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX L'emale
4 COLOR OR RACE
Thite
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
March
2
1948
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Ralph 3. Blazo
(Husband's name in full)
54
years
if less than 1 day
AGE
5.2 Years
Months
Days
Hours
Minutes
Usual
9 Occupation:
House work
Industry
10 or Business:
Own home
Due to
11 Social Security No.
atlanta
12 BIRTHPLACE (City)
(State or country)
Georgia
13 NAME OF
FATHER
( ?)
Callaghan
Major findings :
Of operations
Carcinoma
14 BIRTHPLACE OF
FATHER (City)
Unable to obtain
(State or country)
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
26 Was disease cr isjury la any way related to occupatica of deceased?
If so, specify.
Edward di trau
(Signed)
M. D.
(Address) 19 Wishnella to Date / 2003 1946
21
inthron Cemetery
inthron
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL arch 4
1940
19
22 NAME OF
FUNERAL DIRECTOR
Charles
Bennison
ADDRESS
"inthron .... Lass
40
Received and filed. 8
19
(Registrar)
100m-10-'39. No. 8427-c
17
Informant .. +
Ralph E. Blazo
Relation, if any
husband
(Address )inthron arms Hotel
Inthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burich or yahsit permit was issued: Hiu. S. Children (Signature of Agent of Board of Health & dena) Health Officer 3/4/40
(Official Designation) (Date of Issue of Pernity
19 I HEREBY CERTIFY. That I attended deceased from JUNE 31, 1939, to March 1 1947 ... I last saw h.EI alive on My aich 1 19 /1. death is said to have occurred on the date stated above, at 1.8.1 4.m. Immediate cause of death. General CarcinomaToSIE
Duration IMPORTANT 2.1939
Due to
Carcinoma of Uterus
1-1.39
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis? - Dostalary
Date of ..
2
PARENTS
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent, .
No inthron rms Hotel. Frovers avenue St. 1
(If U. S. War Veteran, specify WAR)
(a) Residence. No inthron
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
In this community 20 yrs.
mos.
days.
5 SINGLE
(write the word)
carried
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness. when last secn alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town. or remove thercfrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issuc such permits, or if there is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforcsaid or from the clerk of the town where the body is buried. No such permit shall be issued until therc shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment. by a satisfactory certificate of the attending physician, if any, as required by law, or in licu thereof a certificate as hercinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the pur- posc, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificatc. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army. navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of deathi shall thereafter fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
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